Procedure Can Help Curb Neuropathy Pain

LAKELAND -- Pain and numbness became a daily part of Mary Hunt's life after she developed diabetic neuropathy -- nerve damage caused by diabetes.

"I would wake up at night because my legs would burn," she said. "The stress it puts you under with the pain is unbelievable."

Yet, the Winter Haven woman could step on a sharp object and not feel anything.

That loss of feeling can lead to serious problems, such as being unable to feel the pedals when driving or an increasing risk of ulcers and infection.

About half of Americans diagnosed with diabetes suffer from some form of nerve damage, according to the American Diabetes Association.

While other conditions can cause neuropathy, diabetes is the most common culprit.

Hunt's neuropathy hasn't gone away, but she said outpatient surgeries this spring eliminated the accompanying pain, tingling and numbness.

What proved effective for Hunt was the Dellon procedure, which involves cutting through connective tissues in the leg and ankle to relieve pressure on the nerve.

Dr. A. Lee Dellon, a plastic surgeon from Johns Hopkins University, designed the procedure to give patients with nerve compression in their legs the relief possible in the wrists from carpal-tunnel surgery.

Though Dellon started developing the procedure more than 15 years ago, it remains relatively unknown. Only a handful of doctors each year train to perform the procedure.

Two Polk County podiatric surgeons began offering the procedure locally in December.

Writing in the October Foot & Ankle International Journal, Dellon said the procedure can "offer a new source of optimism" for patients with neuropathy.

The tarsal tunnel in the ankle is equivalent to the carpal tunnel in the wrist, with the same narrowness that makes it possible for nerves swollen by diabetes to become compressed or pinched, said Dr. Michael Gallina, a local podiatric surgeon.

Dellon, who practices in Baltimore and Tucson, trains other doctors in the procedure. Gallina and Dr. Tatiana A. Wellens-Bruschayt, one of his partners at Central Florida Foot and Ankle Center, took the five-day training in December.

They have performed the procedure on 27 patients since then.

"We were kind of skeptical about it at first," Wellens-Bruschayt said. "We were taught for years that diabetic neuropathy was irreversible."

After learning more about the procedure, however, she said they realized that, although the procedure doesn't offer a cure for neuropathy, it can relieve or eliminate symptoms.

"People wake up in the recovery room, and they can feel their feet," Wellens-Bruschayt said. "They don't have the pain."

For the Dellon procedure, doctors make a 3-inch cut in the leg, a 4-inch cut on the inside of the ankle and a 1-inch cut over the top of the foot.

Surgery opens the tight area through which the nerve passes, giving it more room and allowing for better blood flow, Gallina said.

Recuperation is relatively easy, the local surgeons said.

Patients can walk within a day of surgery, though they must wear a boot for a couple of weeks to let the scars heal.

Wound healing can be slow with diabetics, however. Some patients may need physical therapy before they can resume normal walking if they had been walking on the sides of their feet.

The procedure can be done successfully if there isn't too much damage on the inside of the nerve, Gallina said. Later on in the disease, however, the damage can be irreversible.

Gallina and Wellens-Bruschayt, who maintain offices in Winter Haven and Lakeland, said they use a sensory device designed by Dellon and an engineer for early diagnosis of nerve dysfunction.

They are starting to mail information about the test and surgery to local doctors. Gallina also will speak on the procedure at the National Podiatric Medical Association meeting in Orlando in early August.

"Not only do we relieve pain and ulceration, we reduce amputations," Gallina said. "If you keep a patient walking, you increase their longevity and health."